Pediatric Airway, Snoring, Sleep Apnea and Preventing ADD & ADHD

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Dr Shapira’s Story:  Why he is obsessed with with children’s sleep

I have been treating patients with chronic pain and TMJ disorders since 1978.  Because of my mentor Dr Jim Garry I was acutely aware of how sleep apnea and TMJ disorders had common development aspects.  When my son Billy was 3 years old he had severe snoring would sweat excessively at night.  My wife and I were concerned and took him to several specialists including ENTs and Pediatricians.  They all assured us he was fine and would “outgrow” the problem.  At 5 years old he was evaluated to start kindergarten and we were told he was unable to start kindergarten and that he had ADD & ADHD and would require being on Ritalin.

I rejected the advice of his physicians and went to the Sleep Disorder Service at Rush Presbyterian St Lukes in Chicago.  I was then told insurance would not cover his sleep study (I never asked) but we scheduled it immediately after meeting with Rosalind Cartwright PHd  and Chair of Sleep and Psychology at Rush Medical School.

Billy tested as having severe sleep apnea.  As a result we had his tonsils and adenoids surgically removed and his mouth was orthodontically/ orthopedically widened and the results were instant and amazing.  He slept thru the night and the snoring and sweating were eliminated.  He went from a 50% growth curve to a 90% growth curve and went from short and chubby to tall and skinny almost overnight.  BILL Graduated college double major, double minor Magna Cum Laude, his drug of choice was OXYGEN (from air) and good sleep not Ritalin!

I spent the night at Rush when Billy had his sleep study and discussed what was known and unknown about the development of sleep anea with a post doc Phd .  The information she did not know was in the dental literature, it was exactly what Dr Jim Garry had taught me.  I met with Dr Cartwright and became a visiting Asst Professor at the Sleep Center at Rush Medical School and did research and patient treatment from 1985 until 2001.  My research showed that the physiologic bites of my female TMJ patients was almost identical to the physiologic jaw positions of sleep apnea patients. The testing was done using mandibular kenesiographs and ULF-TENS. I left in 2001 when my wife Elise  was diagnosed with cancer .  As an aside, the initial diagnosis for Billy was “OVERCONCERNED PARENT”.

Dr Cartwright is the Mother of Dental Sleep Medicine, her early work with the Tongue Retaining Device (TRD) was the first peer reviewed articles on Dental Sleep Medicine.  Dr Charlie Samuelson a psychiatrist at university of Chicago invented the TRD but the sleep center at University of Chicago refused to test it.  Dr Cartwright , a pioneer in sleep medicine was open minded enough to look at a new paradigm in sleep medicine beside surgery and CPAP.  The world of medicine owes her a debt of gratitude.

20 dentists from across the US including myself founded the Sleep Disorder Dental Society (SDDS) and became credentialed in sleep medicine.  The SDDS became the American Academy of Dental Sleep Medicine and I became a Diplomat of the American Board of Dental Sleep Medicine and was a founding member of DOSA, the Dental Organization for Sleep Apnea.  I  returned to Rush to teach and treat patients from 1988-2001 and again left when Elise was diagnosed with advanced ovarian caner.

I lost Elise in 2011 to the ovarian cancer but we had a good life in spite of 13 regimens of chemotherapy during that time.  I did not leave my passion for securing early treatment for children behind but rather expanded it greatly, my fiance Anna continues to push me to emphasize the critical importance of Children’s sleep.

in 2001 the NHLBI (National Heart Lung and Blood Institute  of the NIH published a paper titled: THE CARDIOVASCULAR AND SLEEP RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS” .  THE NIH CONSIDERS SLEEP APNEA TO BE A TMJ DISORDER.  THE MOST IMPORTANT FUNCTION OF OUR JAWS, TEETH AND TONGUE ARE NOT TO EAT BUT TO MAINTAIN OUR AIRWAY.

This year in March 2014 I was proud to present a lecture/paper at the International College Of CranioMandibular Orthopedics (ICCMO) ”  I dedicated the paper to my mentor Dr Jim Garry who gave me the knowledge to change Bill’s life.

Headaches, Migraines and TMJ Disorders: The Common Developmental Pathways of TMD and Sleep Disorders Result In ADD, ADHD & Behavioral Problems. Successful Treatment And Prevention Must Be Linked

Treatment of migraines, chronic daily headaches, sleep apnea, fibromyalgia is more successful when you understand the developmental pathways that predispose patients to problems. Solutions are found in Physiologic Dentistry and NasopharyngealAirway

 

Children:  Our most precious asset experience lifetime damage from sleep apnea

The most important patients to address airway issues in are children.  Children with even mild sleep apnea can have pemanent changes in brain development as young as 3 years of age.  The American Academy of Pediatric Medicine says snoring should be taken as a sign  serious potential problem in all children. Even an apnea index of  1 is considered pathologic in children.

Tonsils and Adenoids create changes in CranialFacial Growth

Enlarged tonsils and adenoids create nasopharyngeal airway obstructions.  It is vitally important to create healthy airways as soon as possible.  There are epigenetic changes in growth secondary to airway blockage that create orthopedic changes resulting in compromised airways.  These can lead to sleep disordered breathing.  The mildest form is snoring and the worst is obstructive sleep apnea or suffocation. Upper Airway Resistance Syndrome cuases akakenings when we wrok to breathe (UARS) and hypopneas milder forms of sleep apnea or almost suffocation.  In children any sleep disordered breathing is problematic.  Adult sleep apnea can usually be traced back to preventable changes that occured in childhood.

Sleep Disordered Breathing  in Children are responsible for 80-95% of ADD & ADHD Cases

Research has shown that young developing brains are most affected by sleep apnea.  There is widespread agreement that early treatment can result in healthier children but there is not a consensus in how early treatment should begin.  More and more health  scientists are recommending removal of tonsils and adenoids as young as 1 to 2 years old if obstructive.   Early orthodontic widening is also being recommended in children who have narrow arches.  Sleep disordered breathing also causes endocrine changes affecting maturation (sex hormones) Metabolism (thyroid and insulin function) and growth (Growth Hormone).  Chronic pain and depression are often linked to cortisol levels that are almost always abnormal in patients with sleep apnea.  Weight gain is unquestionably related to poor sleep a real concern during our current epidemic of childhood obesity.

 

 Growing larger pediatric airways with Rapid Maxillary Expansion

Early orthodontic treatment with functional appliances can create a lifetime of better health and breathing.  Rapid Maxillary Expansion is very effective in young children until they are about  8-10 years old.  Rapid maxillary expansion expands not just the upper arch but also the floor of the nose and widens the position of nasla turbinates.  When the maxilla is larger the lower arch or mandible follows and also advances bring the tongue forward as well.  Avoiding ADD and ADHD usually requires treatment before age 8.  Extraction of permanent  teeth instead of expanding the jaws  can actually cause airway problems and sleep apnea.

 

Epigenetic Orthodontics with DNA Appliance:  Creates Orthopedic Growth of Bone and Pneumopedic Growth of Airway

The DNA appliance can grow the bones and airways of older children and adults.  It is possible to grow patients out of sleep apnea.  Ideally children are treated with tonsil and adenctomy and Rapid Maxillary Expansion at younger ages to prevent development of ADD and ADHD.

Adults and teenagers are ideal candidates for the DNA appliance that can be used throughout your life.  The DNA appliance is only worn 12-14 hours a day which makes it the ideal treatment for busy adults who can get  their wear time in during sleep and commuting and is the most comfortable orthodontic treatment available.  The RNA Appliance can grow both upper and lower jaws and act as a a MAD, Mandibular Advancement Device to treat sleep apnea eliminationg the need for CPAP.

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